Sagging and marionette lines in lower face. What are my options? (photos)

Question

I'm so concerned about the sagging in my lower face specifically the jowls and marionette lines. I had a chin implant with facial fat grafting to the nasolabial folds. Ive since had some filler in the chin for asymmetry, a little bit in the jawline by the ear, and in my lips. Ive talked to my med spa about adding filler to the marionette lines but they don't think it will help. It's bothering me to the point where it's all i see on my face. Im only 32. What procedures will help me?

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. You may benefit from dermal fillers as well as a PDO thread lift. Injectable fillers are often used to reduce the appearance of marionette lines and provide powerful, yet subtle anti-aging results.

A PDO thread lift is an excellent choice for addressing skin laxity and early jowl formation. This non-surgical option uses dissolvable sutures to lift tissue and tighten the skin to produce a natural, youthful-looking appearance. I recommend scheduling an in-person consultation with an experienced injector who can help you choose the best approach for your desired results.

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Lucian Ion, FRCS · Answer

Thank you for your enquiry and sharing your photographs.

I feel that your med spa advice was very sensible. Adding volume around the marionette lines unfortunately will make surgical corrections more difficult.

In terms of escalating treatment levels you could consider:

- Minimal intervention treatments like threads

- A minimal access facelift .

- A formal short scar facelift procedure is the most powerful to affect changes for the area of concern to you. It seems however a bit excessive for your age and the magnitude of the problem.

Eric Seiger, DO · Answer

Thank you for your question. After examining your pictures I believe that all you need is what I call an Uppermini facelift, which is a small incision from the top of the ear up and the hairline lifting your cheeks and jowls also. This will do a great job tightening your face. I also believe that mid face filler deep to the bone which we consider a Y lift would also be helpful. Thank you , Dr. Eric Seiger

Ronald J. Edelson, MD · Answer

I think you are too young to have facelift although there are plenty of surgeons who would be willing to perform a facelift on you at your current age. I don’t think it’s wrong to have a facelift but I would turn you down based on your age.

Sagging and marionette lines in lower face. What are my options? (photos)

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Answer: Upper mini facelift

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Sagging and marionette lines in lower face. What are my options? (photos)

Answers (7)

Answer: Upper mini facelift

Answer: Upper mini facelift

Answer: Facelift

Answer: Facelift

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Everything you need to know about Mini Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.